Dr. Brian Goldman: Bringing empathy to health care

As a veteran emergency room physician for more than 30 years, Dr. Brian Goldman has always believed that caring comes naturally to physicians.

Yet he began to question if he was a kind and empathetic soul, after the husband of a patient told him that he had been unkind. The encounter prompted him to crisscross the globe on a two-year exploration, in search of what kindness truly looks like.

Goldman met with the world’s top researchers to analyze his personality. He underwent an MRI scan of his brain to see if he was hard-wired for empathy and investigated the efforts to simulate human empathy and kindness in artificial intelligence.

Goldman spoke with The CJN about his new book, The Power of Kindness: Why Empathy Is Essential in Everyday Life.

Why did you write this book?

It was an important subject for me. As I looked around the hospital, I saw a lot of well-intentioned colleagues, the vast majority of whom wanted to help people. Yet, at the same time, I saw lots of little acts of unkindness for patients. Things like patients lying down in the emergency department hallway for five days at a time with almost no privacy and people having difficult experiences around the death of a loved one. If any of us in health care spent a few hours as patients and family members, we could imagine what it’s like to be them, and we might be appalled at some of the treatment that we provide them.

It was being told that I was unkind on a very memorable occasion that really got me thinking about this. What causes any of us to lose our kindness? Am I a kind soul? I ask these questions in the book, and I hope they are universal questions that everybody wants to answer about themselves.

Please explain empathy.

Empathy is the ability to put one’s self in the place of another human being and act accordingly. To empathize with somebody is to understand what it’s like to be that person.

That’s different than sympathy. Sympathy is a gesture of concern towards somebody else that comes with no particular understanding of what it’s like to be that person.

There are several aspects to empathy. There is emotional empathy, an example of which would be a mother feeling the physical pain of her child getting stitches. The second kind of empathy is called cognitive empathy, which is the ability to use your imagination to picture what it’s like to be another person – for a physician to be able to flip the perspective around and imagine being the patient or the family member. The third aspect is affective concern. That is the motivation to run to the scene of danger, instead of running away from it.

How can empathy transform health care?

Empathy is the way that we establish human connections. Without it, relationships between people are just transactions and devoid of the emotional warmth and meaning that I think is inherent in the human condition. If we could put more empathy into health care, it would mean that patients are more likely to follow the instructions of physicians and to feel assured that the best is being done for them. Family members would feel included in the plans, which means they would be more energized to help out and pitch in and take the instructions from the health-care team and use them to take care of their loved one when they take that person home. Health professionals themselves would feel better about the work that they do, more satisfied and less likely to be burned out.

Are there health consequences of a lack of kindness and empathy?

Yes. Your blood pressure goes up. You feel stressed. Your heart rate goes up. Emotionally, you are unsettled. You may feel guilt. You may feel shame. If you are a health-care provider, you are more likely to be burned out or depressed about your work; if you are a patient or a family member, you are less likely to follow the instructions of the health-care team and that will have consequences on your health, as well.

I met Naomi Feil, a remarkable 86-year-old woman. Her parents escaped Nazi Germany in the late 1930s and arrived with Naomi in America. They were new immigrants and both were health-care professionals who eventually landed positions at a long-term care facility in Ohio.

Having no other place to live, they lived in the nursing home – that was their residence. As a little girl, Naomi’s best friends were the residents. She met one woman in particular named Florence Lue. Florence shared her diary with Naomi, including the story of the worst day of her life. Florence’s mother had been emotionally cruel to her: she came to her school, stood Florence up in the class and grabbed her favourite toy, which was a pet rabbit – a toy made of wood, which her father had made for her. It had wheels on it. The wheels creaked when she rolled it on the floor, so she named it Creaky. Florence’s mother grabbed the rabbit and threw it in the waste paper basket, in front of all the kids and the teacher.

Young Naomi grew up. She went to school and became a social worker and a psychologist. She returned to the nursing home, not as a resident, but as a therapist.

On her first day back, she saw an old, agitated woman – it was Florence, although Naomi had trouble recognizing her. The woman said nothing comprehensible, but kept repeating, “Cre, cre, cre.” Naomi looked at her carefully and suddenly had a flash of insight: Creaky!

Florence briefly recognized Naomi. Florence died that evening.

Naomi made a lightning leap of intuition that people who have advanced dementia at the end of their lives, when they are disoriented from the rest of the world, are not blank, they are not uttering mindless things – the sayings and things they repeat over and over again are meaningful. What they’re doing at the end of their lives is revisiting central dilemmas and emotional conflicts.

It was that story that got Naomi Feil to develop a form of treatment called Validation.

What she does is empathize with people who have dementia. Rather than forcing seniors with dementia into our world, where they would be utterly disoriented, she enters their world. She has taught this method to thousands of therapists around the world.

How do children develop empathy?

By seeing it. I interviewed Mary Gordon about her program, Roots of Empathy, which has been rolled out across many of the education boards in Ontario. The program provides an opportunity for children anywhere from grades 1 to 8, in an age-appropriate fashion, to see a baby from the age of five months develop a sense of self, expressing emotions in the context of a loving and attached family.

I asked Mary, “Can you teach people empathy?” She said, “No, you can’t.” However, the good news is that we are hard-wired for empathy.

How can you teach kids to care? You can ask them curious questions, such as when you see a baby crying, ask them, “Why do you think the baby is crying?” And, leave it to the wisdom of the child to hypothesize. Maybe the child is hungry. Maybe she needs changing, or maybe they notice she tried to grab the toy and she couldn’t and is frustrated. In that, it helps the child recognize the capacity that they already have to empathize with others.